Chapter 9 - Towards practice based commissioning in England
9.1 This one year Directed Enhanced Service (DES) has been developed to support engagement in practice based commissioning (PBC), to encourage practices that have either yet to engage in developing PBC or yet to finalise their plans to do so ahead of the Department of Health’s commitment for universal coverage by 31 December 2006. It also encourages practice engagement through guaranteed resources allocation where deficits in local health economy budgets make the prospect of identified resource even against reduced activity unavailable. This DES complements the latest guidance from the Department of Health published in January 2006. A detailed specification for this DES can be found at Annex 6 .
9.2 The first component of the DES will be payable to practices which prepare and implement a practice based commissioning plan. The payment is in recognition of the practice time needed to develop and implement the practice plan. Practices which agree a written plan with the primary care trust (PCT) will be paid the equivalent of 95p per registered patient based on the practice list size as at 1 April 2006. The DES specification at Annex 6 describes the information and support that PCTs will need to provide their practices in order for the DES plan to be developed and implemented.
9.3 Practices can take upsign up to this DES at any time during 2006/07, however ideally this should . Ideally this should be before the end of April 2006. The expectation is that practices’ DES plans will be agreed and therefore payments awarded by the end of the first quarter of 2006/07. Where this is not possible, for example because a new practice sets up mid year or there is a delay by the PCT in providing data to the practice, PCTs and practices shouldwill agree a prompt date to finalise the DES plan.
9.4 Where practices achieve their DES plan objectives they will be eligible for payment of component 2 at 95p per registered patient (based on the practice list size at 1 January 2007) to be reinvested in practice activity to ensure the continued or improved achievement against the agreed objectives as identified in the plan. Component two will not be available in addition to other freed up resource that already exceeds the value of component two.
9.5 Practices may work alone or in partnership with other practices in taking up this DES. Each practice remains eligible for the award under component one and for either component two or other freed resource to reinvest in practice activity to continue delivering their plan's objectives.
9.6 This DES need not necessarily replace any similar or alternative, locally agreed PBC schemes already in place. This will be for practices and their PCT to decide. However, this DES does describe the minimum amounts that are available to all practices in any PBC scheme in which they engage.
9.7 The DES specification includes an appendix that suggests what the plan for this DES should include. It will be for practices and PCTs to agree on the content and local objectives to be set and for PCTs with their practices to monitor achievement in order for component two to be awarded. Where PCTs and practices agree additional workload for practices, additional resource to this DES should be made available.